Estimation of In Vivo Reticuloendothelial System Phagocytic Activity in Rats by Direct Blood Clearance Techniques and Nuclear Scintigraphy

There has been considerable interest in the examination off reticuloendothelial system phagocytic blockade. In this study, the kinetics of phospholipid liposome‐mediated and intraperitoneal silica‐mediated phagocytic blockade were examined using five methods off analysis off in vivo 99mTc‐labeled albumin clearance and reticuloendothelial cell uptake. Two direct blood sampling techniques revealed significant impairment in 99mTc‐labeled albumin clearance after treatment with silica (P < 0.05), while liposome treatment was not associated with such impairment. A method utilizing nuclear scintigraphy for the determination of blood clearance was incapable of detecting silica‐mediated blockade but demonstrated significant impairment by liposomes at 2 hr (P < 0.001), 6 hr (P < 0.05), and 24 hr (P < 0.001). Gamma camera imaging methods for determination of hepatic uptake demonstrated significant (P < 0.05) and reversible impairment of 99mTc‐labeled albumin uptake by liposomes. The most promising of these techniques utilizes deconvolutional analysis off liver region of interest time–activity curves to correct for continuously changing blood concentrations of tracer and for intracellular tracer processing and catabolism. Measurements of reticuloendothelial system phagocytic activity should include methods that take into account the observed discrepancies between blood clearance determinations and reticuloendothelial cell uptake.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141016/1/jlb0060.pd

Using network analysis to model the effects of the SARS Cov2 pandemic on acute patient care within a healthcare system.

Funder: Mayo Clinic Practice Innovation GrantFunder: Mayo Clinic Kern Centre for the Science of Healthcare Delivery grantConsolidation of healthcare in the US has resulted in integrated organizations, encompassing large geographic areas, with varying services and complex patient flows. Profound changes in patient volumes and behavior have occurred during the SARS Cov2 pandemic, but understanding these across organizations is challenging. Network analysis provides a novel approach to address this. We retrospectively evaluated hospital-based encounters with an index emergency department visit in a healthcare system comprising 18 hospitals, using patient transfer as a marker of unmet clinical need. We developed quantitative models of transfers using network analysis incorporating the level of care provided (ward, progressive care, intensive care) during pre-pandemic (May 25, 2018 to March 16, 2020) and mid-pandemic (March 17, 2020 to March 8, 2021) time periods. 829,455 encounters were evaluated. The system functioned as a non-small-world, non-scale-free, dissociative network. Our models reflected transfer destination diversification and variations in volume between the two time points - results of intentional efforts during the pandemic. Known hub-spoke architecture correlated with quantitative analysis. Applying network analysis in an integrated US healthcare organization demonstrates changing patterns of care and the emergence of bottlenecks in response to the SARS Cov2 pandemic, consistent with clinical experience, providing a degree of face validity. The modelling of multiple influences can identify susceptibility to stress and opportunities to strengthen the system where patient movement is common and voluminous. The technique provides a mechanism to analyze the effects of intentional and contextual changes on system behavior

American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2016-2017)

The American Board of Emergency Medicine (ABEM) gathers extensive information on emergency medicine residency programs and the residents training in those programs. Survey data are collected annually from all emergency medicine programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Selected parts of the data are reported in this article.† Also included in this report is information on accredited emergency medicine–sponsored fellowship programs reported by the ACGME

American Board of Emergency Medicine Report on Residency Training Information (2015-2016)

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2016 annual report on the status of US emergency medicine training programs